EMT says nurse should lead in most situations
Occupational health nurses tend to say they should be in charge of medical care at a work site even if an emergency medical technician (EMT) is on site, and that view is supported from the EMT side of the issue.
Paul Ezelle, EMT-P, is an EMT-paramedic and president of Ezelle Medical Services in Mobile, AL. Ezelle also is co-chairman of the industrial division of the National Association of Emergency Medical Technicians in Clinton, MS. He works with industry clients to set up on on-site EMT programs and often encounters conflicts between EMTs and occupational health professionals.
"This is an inherent problem across the country. It’s wasted time and energy," he says. "Nurses can be threatened by paramedics in industry, but really they are two different creatures and should not be threatened by each other. A paramedic’s main function is in an emergency, whereas the nurse has a great deal more to deal with on a daily basis."
When Ezelle sets up emergency response plans for his client companies, he usually designates the on-site occupational health nurse as the team leader. (If there is an occupational health physician on-site, the physician obviously has authority over the other medical personnel.) That decision does not always go over well with the EMT, he says, but Ezelle bases that decision largely on the relative experience of the two professionals.
In most industrial settings, Ezelle says the EMT will be someone trained in emergency medicine but whose main job is something else within the facility, as opposed to an EMT who has spent years "in the streets" gaining knowledge and experience. The occupational health nurse, however, is likely to be someone with years of experience in a hospital setting or other occupational health work, he says. That means the occupational health nurse should take the lead in most situations, he says.
"But don’t forget that the EMT has skills that the nurse does not have, such as extricating a patient from machinery," he says. "The nurse would be wise to lean on the EMT’s knowledge and training in that situation."
If the on-site EMT does have years of experience working full-time on the street as an EMT, that might change the mix, Ezelle says. The coordination with the occupational health nurse might be different in that situation, he says, with the nurse allowing more latitude for the EMT to participate in non-accident, non-emergency situations. Like occupational health consultants, he says the two parties must learn to cooperate.
"Nurses have to be comfortable in knowing that the EMT is not there to replace them," he says. "Management needs to assure nurses that they’re needed and doing important things that are totally outside the realm of the paramedic."
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